Adams S L, Roxe D M, Weiss J, Zhang F, Rosenthal J E
Department of Medicine, Northwestern University Medical School, Chicago, IL, USA.
Acad Emerg Med. 1998 Sep;5(9):871-7. doi: 10.1111/j.1553-2712.1998.tb02816.x.
Occupational stress may affect measured hemodynamic and electrocardiographic variables. Data describing the physiologic effects of work on the emergency physician (EP) are sparse.
To determine whether blood pressure (BP) and heart rate variability (HRV) of the EP are affected during a night shift in the ED.
This prospective study evaluated BP and HRV in attending EPs at an urban academic medical center for a 24-hour period during which a night shift was scheduled. Participants were fitted with an oscillometric ambulatory BP device and a Holter monitor at 1500 hours on the day of a night shift. The monitors were worn continuously before, during, and after a night shift (2300-0700) in the ED and were removed at 1500. Systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), measures of HRV, and occurrence of cardiac dysrhythmias were evaluated. Comparisons were made for ED and non-ED awake periods and non-ED sleep periods.
Twelve participants completed the study. Eight (67%) subjects were men and 4 (33%) were women. Age ranged from 28 to 40 years (mean 34.1+/-4.1). Results were analyzed using repeated-measures ANOVA. An elevation of mean DBP (5.5 mm Hg+/-4.37; p < 0.05; 95% CI 1-10) during night shift activity was seen. A trend toward elevation of SBP, MAP, and HR was discernible. HRV measures indicated a significant relative increase in sympathetic vs parasympathetic tone and an increase in HR of prework and work compared with postwork. Dysrhythmias observed included sinus tachycardia, sinus bradycardia, sinus pause, atrial premature beats, atrial couplets and triplets, supraventricular tachycardia, and premature ventricular contractions.
The elevation of DBP during a night shift suggests that these patterns of BP variability are activity- or stress-related rather than a result of a true diurnal variation. HRV analysis suggests that sympathetic tone is heightened both before work and during work. The implications of such findings to the health of the EP warrant further investigation.
职业压力可能会影响所测量的血流动力学和心电图变量。描述工作对急诊医师（EP）生理影响的数据较为稀少。
确定急诊医师在急诊科夜班期间其血压（BP）和心率变异性（HRV）是否受到影响。
这项前瞻性研究评估了一所城市学术医疗中心的在职急诊医师在安排有夜班的24小时期间的血压和心率变异性。参与者在夜班当天15:00时佩戴动态血压监测仪和动态心电图监测仪。这些监测仪在急诊科夜班期间（23:00 - 07:00）及之前、之后持续佩戴，并于15:00取下。评估收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、心率变异性指标以及心律失常的发生情况。对急诊科清醒时段、非急诊科清醒时段和非急诊科睡眠时段进行了比较。
12名参与者完成了研究。8名（67%）受试者为男性，4名（33%）为女性。年龄范围为28至40岁（平均34.1±4.1）。使用重复测量方差分析对结果进行分析。观察到夜班活动期间平均舒张压升高（5.5 mmHg±4.37；p < 0.05；95%可信区间1 - 10）。收缩压、平均动脉压和心率有升高趋势。心率变异性指标表明，与工作后相比，交感神经与副交感神经张力相对显著增加，且工作前和工作期间心率升高。观察到的心律失常包括窦性心动过速、窦性心动过缓、窦性停搏、房性早搏、房性成对早搏和三联律、室上性心动过速以及室性早搏。
夜班期间舒张压升高表明这些血压变异性模式与活动或压力相关，而非真正的昼夜变化结果。心率变异性分析表明，工作前和工作期间交感神经张力均升高。这些发现对急诊医师健康的影响值得进一步研究。
